Technology update: Understanding hydrocolloids
09/11/09 | Skin integrity | Douglas Queen
Over the past 30 years a plethora of advanced wound dressings have been introduced. Hydrocolloid dressings have led this woundcare revolution and helped clinicians recognise the importance of moist wound healing. Today, hydrocolloid use has become routine and the dressing evolution has led to the development of other dressing technologies.
THE EVOLUTION OF WOUND CARE
Wounds are not a 21st century problem. They have been a constant challenge throughout the history of mankind. Today we have the ability to treat a whole range of different wounds and potentially save lives.
Historically, many materials have been used in the treatment of wounds, ranging from grease-soaked bandages to what can best be described as sophisticated cloth. The treatment of wounds has traditionally been the remit of surgeons or doctors, but over the past century that remit has expanded to include nurses. Modern medicine sees a more multidisciplinary approach to care as the treatment of wounds has developed from an art to a clinical specialty.
Wound care has evolved primarily as a result of the evolution of other clinical areas (such as endocrinology and the treatment of diabetes), and treatment options have become more advanced.
The evolution began with the more sophisticated 'cloths' (gauzes) where clinicians and scientists worked together to eliminate the limitations and clinical complications of existing treatments. One of the most significant scientific discoveries to impact on the evolution of wound treatments was that of George Winter in the early 1960s. His discovery was counter to the established wisdom of the time. Traditional practice was to use gauze to 'soak up' the wound fluid, allowing wounds to dry out, scab over and ultimately heal. Winter discovered that the opposite was true in that keeping the wound moist led to faster and better quality healing .
As a result of Winter's findings, researchers and clinicians alike began to rethink clinical practice . New dressings were developed based on plastics, with the first being film dressings in the 1970s, which primarily utilised polyurethane technology . However, the adoption of film dressings was limited initially for two main reasons. First, changing clinical practice, especially practice that has been established for centuries, does not happen overnight. Achieving change is complex and requires a concerted effort to show clinicians that changing practice has benefits both for the patient and the clinician.
Second, the companies marketing the film dressings also had established businesses in the traditional dressings arena, so were in effect competing against themselves while also seeking to market a new technology and persuade clinicians to adopt it.
During the 1980s, however, clinical practice was beginning to change, albeit very slowly. Although the benefits of healing in a moist environment had been published worldwide, the use of woven gauze as a wound contact material still prevailed in many countries .
HISTORY OF HYDROCOLLOID DRESSINGS
With the increasing use of film dressings, clinicians began to see limitations and this created an opening for an alternative. The most significant development, however, was the evolution of hydrocolloid technology from its use in stoma care to its use in wound care. A clinician treating stoma patients noticed that the edges of the stoma looked healthier and began to heal when under hydrocolloid wafers. This led to the development of hydrocolloid dressings for wound care and the moist wound healing revolution really began.
Revolution may seem to be a strange and strong statement; however, the introduction of hydrocolloids to the treatment of wounds drove both the clinical and technological adoption of the findings of Winter some 20 years after his discovery of the importance of moist wound healing .
This revolution was also spurred on in the 1980s by a more aggressive approach to the marketing of hydrocolloids than to that of previous dressings.
- The polyurethane film dressing was the first to adopt the principles of moist wound healing
- Hydrocolloid dressings heralded the beginning of the moist wound healing revolution